Acromioclavicular (“AC”) joint dislocations are characterized by severe upward displacement of the lateral end of the clavicle relative to the acromium of the scapula. Surgery is recommended to reduce and internally fix the displacement, which could otherwise lead to a painful deformity and loss of function.
This invention relates to reconstruction surgery and particularly to reconstruction surgery for Rockwood types II-VI AC joint dislocations of the shoulder (Rockwood, Williams, & Young, Injuries to the Acromioclavicular Joints, in FRACTURES IN ADULTS 1341-1413 (Rockwood & Green, eds., 3rd ed., 1996)). More particularly, the invention relates to the use of a first suture anchor-suture-second suture anchor technique to reduce and internally fix the dislocation between the clavicle and the coracoid process.
Injuries to the AC joint are generally classified as types I-VI, depending on the type and amount of disruption to the AC and the coracoclavicular ligaments. A type III AC dislocation of the shoulder is a common injury that occurs primarily from having a fall to the point of the shoulder. A type III injury is characterized by disruption of the AC and coracoclavicular ligaments, the dislocation of the AC joint and the upward relative displacement of the lateral end of the clavicle. The coracoclavicular interspace is greater than in the normal shoulder.
There are presently two basic treatment options available: non-operative treatments and operative procedures.
The non-operative option includes external, closed reduction. Various external, closed reduction procedures have been tried in the past using straps, casts, and different taping techniques. Generally, it has been believed that the procedures would work if applied continuously. Unfortunately, it has been found not to work as no one can wear them continuously because of skin breakdown and discomfort. As a result, such treatment regimes rarely have been successful. The patient must inevitably accept a cosmetic deformity and suffer from pain and fatigue after prolonged physical activity or heavy lifting.
Operative treatments to date have focused on open reduction and direct repair or reconstruction of the ligaments. This procedure corrects the deformity and is generally accepted as providing the best results. However, this usually entails an extensive open operation. The deltoid and trapezius muscles are taken off the clavicle and dissected to expose the underside of the clavicle and the coracoclavicular ligaments and the coracoid process. The procedure requires an in-hospital stay, extended time for the surgical wound to heal, and rehabilitation. The open reduction procedure is generally recommended as the treatment of choice for people involved in heavy lifting work or active athletics. The remaining population is generally told to accept the deformity and to accept the pain and fatigue after heavy lifting or activity.
It is well-known in the art to fix the coracoclavicular space by drilling a hole through the clavicle and into the coracoid process and by then inserting a screw (a Bosworth screw, for example) therebetween. It is also well-known to loop a flexible coupling such as a nylon tape around both the coracoid and the clavicle and to knot them together. This has the disadvantage of requiring that all of the coracoid be exposed. It is also known to drill a hole in the coracoid process and attach a single suture anchor, with a pair of sutures extending therefrom, into the coracoid. The free ends of the sutures are then looped about the clavicle and tied to each other.
Non-operative treatment options generally provide unacceptable results. The open reduction treatment, while providing generally good results, has the disadvantage of an in-hospital stay plus the extensive time required for healing and rehabilitation. A surgical outpatient technique that would correct the deformity and allow healing of the injury in a normal anatomic position without extensive tissue dissection and less scarring would provide a substantial improvement over current treatment methods.
It is an object of the present invention to overcome the problems associated with the prior art, whilst permitting normal physiological movement of the clavicle relative to the coracoid.